A. Ritalin, manufactured by Ciba-Geigy, is a stimulant and its
effects are similar to the effects of other stimulants including
amphetamine, methamphetamine, and cocaine.

Q. What does Ritalin treat?

A. Ritalin is used to treat Attention Deficit and Hyperactivity
Disorder (ADHD). ADHD is a central nervous system problem of unknown
causes that occurs in children of both sexes, but is diagnosed
four times more frequently in boys. ADHD is defined by the Merck
Manual as "developmentally inappropriate inattention and impulsivity,
with or without hyperactivity." Symptoms include distraction,
impatience, and difficulty concentrating.

Q. How often is Ritalin prescribed?

A. There are six million prescriptions for Ritalin filled annually.
The U.S. pharmacists distribute five times more Ritalin than the
rest of the world combined; no other nation prescribes stimulants
for its children in such volume. In fact, the United Nations International
Narcotics Control Board has on two recent occasions written to
U.S. officials expressing concern about the six-fold increase in
Ritalin usage since 1990. Approximately 3 to 5 or more percent
of U.S. children and teenagers have been or are being prescribed
Ritalin.

Q. What are the side effects of Ritalin?

A. As a stimulant of the central nervous system, Ritalin's side
effects include increased blood pressure, increased heart rate,
increased body temperature, increased alertness and suppressed
appetite. Ritalin is typically used on a daily basis with a hiatus
on weekends or during the summer. Because it is ingested almost
daily for a period of years, there are major concerns over chronic
health effects.

Q. Is Ritalin carcinogenic?

A. After more than forty years of prescribing Ritalin, the FDA
along with the National Cancer Institute called for more testing "because
of its widespread use in human medicine and - lack of data on its
potential carcinogenicity." The National Toxicology Program
accepted responsibility for conducting trials on carcinogenicity
and in June 1993 released results showing that feeding mice Ritalin
induced liver tumors including very rare and highly malignant cancers.
These results were found at levels close to those routinely prescribed
for children. More studies are being planned for testing Ritalin,
but the evidence is strong. Animal tests are very good predictors
of human health effects. In fact, the International Agency for
Research on Cancer suggests that if a chemical is proven to cause
cancer in animals, it should be treated as if it were cancer-causing
in humans as well.

Q. How did Ciba-Geigy and the FDA respond to information that
Ritalin is cancer-causing?

A. The response of the FDA and Ciba-Geigy to the cancer test results
were not adequately protective of child health. The FDA deputy
drug director said, "We felt physicians and parents should
know this and have a right to know this. But it's not enough of
a signal that we think kids should be taken off the drug." Ciba-Geigy
wrote to 100,000 physicians informing them of the National Toxicology
Program's study and reassured them that Ritalin is believed to
be "safe and effective" by the FDA.

But with information that Ritalin does cause cancer in laboratory
animals, it can not be deemed "safe." Animal tests are
very reliable predictors of human effects. Of the 23 known human
carcinogens, all were identified as carcinogens in animals first,
sometimes decades earlier. It is disconcerting that the FDA is
not making a move to ban or limit the use of this drug.

Q. Are there alternatives to Ritalin in the treatment of ADHD?

A. Yes. While Ritalin is the most commonly used drug for attention
deficit disorders, now prescribed to 60 to 90 percent of American
children with such disorders, there are pharmacological alternatives.
There are also non-drug therapies for ADHD and related mental health
problems. For example, behavior modification therapy has been particularly
effective with ADHD cases.

The treatment recommendations for stimulants like Ritalin almost
always recommend concurrent behavioral therapy or psychotherapy.
This is particularly important when a child is being treated for
ADHD. Diagnosis of ADHD is often made in cases where other problems
are prevalent and a comprehensive mental health examination has
not been conducted. Poor hearing, learning disabilities, and stress
at home may be factors in such misdiagnosis. In one known case,
a child was prescribed Ritalin after a five-minute examination
and was subsequently taken off of the medication when it was discovered
that he was borderline mentally retarded. The causes of childhood
impulsivity and hyperactivity must be carefully explored before
an ADHD diagnosis is made.